The Four Patient Types Who Fall Through the Cracks – and Why That Should Concern Us
Tania Malan
Founder | Clinical Director at Uniskin | Co-Founder of Ageless by Design Best-Selling Author | Global Speaker | Pioneer in Personalised Medicine & Extended Healthspan
September 9, 2025
Modern healthcare is highly effective at identifying and treating disease. But it often falters when the issue isn’t disease, but dysfunction.
In our clinical work, we’ve come to recognise four types of patients who are routinely underserved — not because they aren’t trying to seek help, but because the system isn’t designed to understand what’s going on beneath the surface.
Here are the four we see most often:
1. The Grey Patient
They’re not acutely ill, but they’re certainly not well. These individuals live in the “grey zone” — experiencing persistent fatigue, brain fog, recurrent headaches, low mood, and poor immunity. Often, their conventional blood work is unremarkable. And yet, they don’t feel right. There’s something missing, but no clear pathology to chase. So they’re told: “Everything looks fine.”
2. The Elderly
Symptoms of decline — fatigue, poor sleep, declining resilience, aches and pains — are routinely attributed to age. But aging and suffering are not synonymous. Many physiological imbalances in older patients are both measurable and modifiable, but they’re not investigated because expectations have already been lowered.
She’s 81, She still skis, walks for miles and laughs harder than most twenty-somethings
“This is such a disservice. We lower expectations instead of raising questions. We accept decline instead of investigating and supporting full potential. Age does not disqualify someone thriving” – Tania Malan
3. The Chronically Diagnosed
Those with an existing diagnosis — autoimmune conditions, diabetes, endometriosis, arthritis — often have new symptoms dismissed as “part of the condition.” Once a diagnostic label is applied, the exploration tends to stop. But these patients may still have correctable issues (nutrient depletions, gut dysfunction, toxic load) that could significantly impact their quality of life.
4. The Biohacker / Health Hacker
These are the motivated ones. Often highly engaged, they’re seeking to optimise their health but feel overwhelmed by fragmented data, wearables, and protocols. They need a framework — not more inputs — to translate effort into meaningful results.
Why Do These Patients Get Missed?
Because we confuse the absence of pathology with the presence of health.
Conventional medicine is excellent at identifying disease once it crosses a threshold. But symptoms often appear long before diagnostic criteria are met. In that in-between space — where the patient is symptomatic, but the labs are “normal” — there is often no clear path forward.
This is the blind spot: the divide between clinical dysfunction and diagnosable disease.
What’s Needed: A New Lens, Not Just More Tests
This is where a more systems-oriented, personalised approach becomes essential. Start by asking: What if the problem is not in the pathology, but in the physiology?
Our framework begins at the genomic level — identifying inherited vulnerabilities in detoxification, methylation, neurotransmitter metabolism, or immune function — and then overlays functional testing to explore how those pathways are performing under real-world conditions.
Whether it’s:
- Microbiome and gut barrier integrity
- Hormonal rhythms and stress responses
- Mitochondrial efficiency and energy production
- Nutrient cofactors and metabolic balance
— the goal is to understand the mechanism behind the symptom, not just to chase a diagnosis.
Toward a More Precise and Compassionate Model
Each of these patient types is offering us a signal — not necessarily of disease, but of imbalance. To overlook them is to miss an opportunity not just for early intervention, but for optimisation.
This is the essence of our work: To listen more closely. To interpret symptoms differently. To investigate not only when something is broken, but when something is not quite right.
Because health is not the absence of disease — it’s the presence of function.
Tania Malan (Founder Uniskin, Co-Founder Ageless by Design)